Apparatus for treating a portion of a reproductive system and related methods of use

ABSTRACT

A medical device for performing a surgical procedure may include an elongate member having a proximal end, a distal end, and a lumen extending therebetween. The medical device may also include a handle connected to the proximal end of the elongate member, an end effector assembly connected to the distal end of the elongate member, and a cutting device configured to extend from the end effector assembly, wherein the cutting device has a retracted configuration in which the cutting device is withdrawn into the end effector assembly and a deployed configuration in which the cutting device extends from the end effector assembly.

CROSS-REFERENCE TO RELATED APPLICATION

This patent application is a continuation of U.S. application Ser. No.14/081,100, filed Nov. 15, 2013, entitled APPARATUS FOR TREATING APORTION OF A REPRODUCTIVE SYSTEM AND RELATED METHODS OF USE, now U.S.Pat. No. 10,034,687, which is a continuation of U.S. application Ser.No. 13/214,595, filed Aug. 22, 2011, entitled APPARATUS FOR TREATING APORTION OF A REPRODUCTIVE SYSTEM AND RELATED METHODS OF USE, now U.S.Pat. No. 8,608,738, which claims the benefits of priority under 35U.S.C. §§ 119-120 to U.S. Provisional Application No. 61/420,308, filedon Dec. 6, 2010, entitled IMPROVED METHOD FOR TOTAL LAPROSCOPICHYSTERECTOMY AND LAPROSCOPIC SUPRACERVICAL HYSTERECTOMY USING A NOVELUTERINE AMPUTATION DEVICE, the entire disclosures of which areincorporated herein by reference.

FIELD OF THE INVENTION

Embodiments of the present disclosure generally relate to devices andmethods for treating a portion of a reproductive system of a femalepatient. More particularly, embodiments of the present disclosure relateto devices and methods for uterine amputation, among other things.

BACKGROUND OF THE INVENTION

The female reproductive system includes, among other things, ovaries,fallopian tubes, a uterus, a cervix, and a vagina. As a result ofcertain gynecological conditions, such as cancers or severe pain andheavy bleeding, however, it sometimes becomes necessary to treat apatient's uterus. One option for treating the uterus includes surgicallyremoving the uterus via a hysterectomy procedure.

One hysterectomy procedure is known as a radical hysterectomy and itinvolves the complete removal of a patient's uterus, cervix, uppervagina, and parametrium. Another hysterectomy procedure is known as atotal hysterectomy and it involves the complete removal of a patient'suterus and cervix. In some cases, however, a patient may only require asupracervical hysterectomy (also known as a partial hysterectomy), whichinvolves the removal of the uterus but otherwise leaves the cervix insitu.

Initially, hysterectomy procedures were performed via an incision in apatient's abdomen. With advancement in surgical tools and procedures,however, hysterectomy procedures have evolved to include vaginal andlaparoscopic techniques. Today, therefore, hysterectomy procedurestypically involve one of four primary approaches: total abdominalhysterectomy (TAH), total vaginal hysterectomy (TVH), total laparoscopichysterectomy (TLH), and laparoscopic supracervical hysterectomy (LSH).

The medical literature has increasingly shown that the TLH and LSHapproaches are preferred over the conventional TAH and TVH approaches.The TLH and LSH approaches are preferred because of several patientbenefits, including, for example, less postoperative pain, shorterhospital stays, and faster recovery times. However, only a smallpercentage of hysterectomies performed each year are conducted via theTLH or LSH approach. Often, the reasons for performing a hysterectomywithout using a TLH or LSH approach include the inherent limitations oflaparoscopic surgery in general. These limitations include limitedvisibility, difficulty in manipulating internal organs with laparoscopictools, and subsequent control of the operative field. In addition,surgeons often cite an increase in complication rates for avoiding TLHor LSH approaches. One such complication includes vaginal cuffdehiscence, which is thought to be caused by a tendency to “wander”during the cauterization/cutting procedure used to excise the uterus.Accordingly, there is a need for apparatuses and methods that are lessinvasive, allow for uniform excision, and/or reduce operation time.

SUMMARY OF THE INVENTION

Embodiments of the present disclosure provide apparatuses and methodsfor treating a portion of a reproductive system.

An aspect of the present disclosure includes a medical device forperforming a surgical procedure. The medical device may include anelongate member having a proximal end, a distal end, and a lumenextending therebetween. The medical device may also include a handleconnected to the proximal end of the elongate member, an end effectorassembly connected to the distal end of the elongate member, and acutting device configured to extend from the end effector assembly,wherein the cutting device has a retracted configuration in which thecutting device is withdrawn into the end effector assembly and adeployed configuration in which the cutting device extends from the endeffector assembly.

In various embodiments, the medical device may include one or more ofthe following additional features: the end effector assembly may includea cup; the end effector assembly may include an elongate manipulationmember having a proximal portion, a distal portion, and a centralportion extending therebetween, wherein the central portion may includea substantially uniform cross-section; the cutting device may be furtherconfigured to rotate about a longitudinal axis of the end effectorassembly; a first actuator may control deployment of the cutting deviceand a second actuator may control rotation of the cutting device; thecutting device may be a monopolar cauterizing instrument; the cuttingdevice may be a bipolar cauterizing instrument; the medical device mayfurther comprise an expandable member secured to a distal portion of themedical device; the expandable member may be secured to the elongatemember; the medical device may further comprise an expandable membersecured to the elongate manipulation member; the medical device mayfurther comprise an elongate manipulation member extending distally fromwithin the cup; the medical device may further comprise a firstexpandable member secured to a distal portion of the elongate member;the medical device may further comprise a second expandable membersecured to the elongate manipulation member; the cup may include a firstcup portion and a second cup portion disposed within the first cupportion, wherein a gap exists between the first and second cup portions,and the cutting device is slidably disposed within the gap; the cuttingdevice may be a cautery ring; the cautery ring may include a segmentedring; the expandable member may be disposed proximally of the endeffector assembly; the end effector assembly may be configured to pivotrelative to the elongate member; the end effector assembly may beremovably secured to the distal end of the elongate member; and the endeffector assembly may be longitudinally movable relative to a distal endof the elongate member.

In another aspect, a method for performing a laparoscopic hysterectomyprocedure may include inserting a medical device into a vaginal canal ofa patient. The medical device may include an elongate member having aproximal end, a distal end, and a lumen extending therebetween, a handleconnected to the proximal end of the elongate member, an end effectorassembly connected to the distal end of the elongate member, and acutting device configured to extend from the end effector assembly,wherein the cutting device has a retracted configuration in which thecutting device is withdrawn into the end effector assembly and adeployed configuration in which the end effector extends from the endeffector assembly. The method may further include positioning the endeffector adjacent tissue associated with one of uterine or cervicaltissues, deploying the cutting device, and creating an incision toexcise at least a uterus of the patient from surrounding tissue.

In various embodiments, the medical device may include one or more ofthe following additional features: the end effector may include a cupand an elongate manipulation member extending distally from within thecup; the medical device may further include a first expandable memberdisposed on the elongate member at a location proximal of the endeffector assembly; the method may further comprise expanding theexpandable member to occlude the vaginal canal; prior to the step ofdeploying the cutting device, the method may further include pivotingthe elongate manipulation member to alter a positioning of the uterus;prior to the step of deploying the cutting device, the method mayfurther include positioning a rim of the cup against a vaginal forniceand exerting a cephalad force on the vaginal fornice; creating anincision to separate at least a uterus of the patient from surroundingtissue may include rotating the cutting device; the cutting device maybe a monopolar cautery instrument; the cutting device may be a bipolarcautery instrument; the medical device may include a second expandablemember secured to the elongate manipulation member; the cutting devicemay be a cautery ring; the cautery ring may include a segmented ring;rotating the cutting device may include rotating the end effectorassembly; the end effector assembly may be removably secured to thedistal end of the elongate member; the end effector assembly may belongitudinally movable relative to the distal end of the elongatemember; the method may further comprise the step of removing cervicaltissue; and creating an incision to excise at least a uterus of thepatient from surrounding tissue may include excising the uterus and acervix of the patient.

A further aspect may include a medical device for performing a surgicalprocedure. The medical device may include an elongate member having aproximal end, a distal end, and a lumen extending therebetween, a handleconnected to the proximal end of the elongate member, an end effectorassembly connected to the distal end of the elongate member, a cuttingdevice configured to extend from the end effector assembly, wherein thecutting device has a retracted configuration in which the cutting deviceis withdrawn into the end effector assembly and a deployed configurationin which the cutting device extends from the end effector assembly,wherein the cutting device is configured to rotate about a longitudinalaxis of the end effector assembly, and wherein the cutting deviceincludes a cauterizing instrument. The medical device may also includean expandable member positioned on the elongate member at a locationproximal of the end effector assembly.

Additional objects and advantages of the disclosure will be set forth inpart in the description that follows, and in part will be obvious fromthe description, or may be learned by practice of the disclosedembodiments. The objects and advantages of the disclosure will berealized and attained by means of the elements and combinationsparticularly pointed out in the appended claims.

It is to be understood that both the foregoing general description andthe following detailed description are exemplary and explanatory only,and are not restrictive of the invention, as claimed.

BRIEF DESCRIPTION OF THE DRAWINGS

The accompanying drawings, which are incorporated in and constitute apart of this specification, illustrate several embodiments of thedisclosure and, together with the description, serve to explain theprinciples of the embodiments disclosed herein.

FIG. 1 is a perspective view of a medical device for performing a totallaparoscopic hysterectomy (TLH) procedure, according to a firstembodiment of the present disclosure.

FIG. 2A is a perspective view of the medical device of FIG. 1 having acutting device in a retracted position.

FIG. 2B is a perspective view of the medical device of FIG. 1 having acutting device in a deployed position.

FIG. 3 is an exploded view of the medical device of FIG. 1 .

FIG. 4A is a sectional view of a distal end of the medical device ofFIG. 1 .

FIG. 4B depicts an alternate embodiment of a cutting device for use withthe medical devices disclosed herein.

FIG. 4C depicts a further embodiment of a cutting device for use withthe medical devices disclosed herein.

FIG. 5A is a top view of a preoperative patient setup.

FIG. 5B is an anterior view of a patient being prepared for alaparoscopic hysterectomy procedure.

FIG. 5C is a posterior view of a patient being prepared for alaparoscopic hysterectomy procedure.

FIG. 6 is an internal view of a body portion undergoing a step ofcutting ligamentus structures in a laparoscopic hysterectomy procedure.

FIG. 7A is an internal view of a body portion showing laparoscopic toolsin conjunction with the medical device of FIG. 1 inserted into a vaginalcavity for performing a TLH procedure.

FIG. 7B is a cross-sectional view of the body portion of FIG. 7A showinga laparoscopic tool in conjunction with the medical device of FIG. 1inserted into a vaginal cavity for performing a TLH procedure.

FIG. 8A is a cross-sectional view of a body portion showing a cup of thedistal end of the medical device of FIG. 1 engaging vaginal fornices ofa patient.

FIG. 8B is a cross-sectional view of a body portion showing thecolpotomy cup inserted and extending into an apex of the vaginalfornices following a cephalad push.

FIGS. 9A-9C are sectional views of a body portion showing the cuttingdevice of FIG. 4A excising the uterine cervix from the vagina during aTLH procedure.

FIG. 10 is a perspective view of a medical device for use in performinga TLH procedure, according to a second embodiment of the presentdisclosure.

FIG. 11 is a perspective view of the medical device of FIG. 10 showingrotated configurations of its proximal and distal ends, and with acutting device in a deployed configuration.

FIGS. 12A-12B are cross-sectional views of a cup of the medical deviceof FIG. 10 with a cutting device in deployed and retractedconfigurations, respectively.

FIG. 13 is a perspective view of a medical device for use in performinga TLH procedure, according to a third embodiment of the presentdisclosure.

FIG. 14A is a cross-sectional view of a body portion showing the medicaldevice of FIG. 10 inserted into a vaginal cavity for performing a TLHprocedure.

FIG. 14B is a cross-sectional view of a body portion showing the medicaldevice of FIG. 10 inserted into a vaginal cavity and manipulating aposition of a uterus for performing a TLH procedure.

FIG. 15 is a perspective view of a medical device for use in performinga TLH procedure, according to a fourth embodiment of the presentdisclosure.

FIG. 16 is an exploded view of the medical device of FIG. 15 .

FIGS. 17A-17B are cross-sectional views of a body portion showing themedical device of FIG. 15 with a deployed cutting device separating theuterus during a TLH procedure.

FIG. 18 is a perspective view of a medical device for use in performinga laparoscopic supracervical hysterectomy (LSH) procedure, according toa fifth embodiment of the present disclosure.

FIG. 19 is a perspective view of the medical device of FIG. 18 showing acutting device in a deployed configuration.

FIG. 20 is a cross-sectional view of a distal end of the medical deviceof FIG. 18 showing a cutting device in a retracted configuration.

FIGS. 21A-21B are cross-sectional views of a distal end of a medicaldevice for use in performing an LSH procedure, according to a sixthembodiment of the present disclosure, showing a cutting device inretracted and deployed configurations, respectively.

FIG. 22A is a cross-sectional view of a body portion showing the medicaldevice of FIG. 18 inserted into a vaginal cavity for performing an LSHprocedure.

FIG. 22B is a cross-sectional view of a body portion showing the medicaldevice of FIG. 18 inserted into a vaginal cavity and manipulating theposition of a uterus for performing an LSH procedure.

FIG. 23 is a perspective view of a medical device for use in performingan LSH procedure, according to a seventh embodiment of the presentdisclosure.

FIGS. 24A-24B are perspective views of the medical device of FIG. 23with a cutting device in retracted and deployed positions, respectively.

FIG. 25 is a sectional view of a distal end of the medical device ofFIG. 23 .

FIG. 26 is an exploded view of the medical device of FIG. 23 .

FIG. 27 is a perspective view of a medical device for use in performingan LSH procedure, according to an eighth embodiment of the presentdisclosure.

FIGS. 28A-28B are perspective views of the medical device of FIG. 27with a cutting device in first and second rotational positions,respectively.

FIG. 29 is an exploded view of the medical device of FIG. 27 .

FIG. 30 is a sectional view of a distal end of the medical device ofFIG. 27 .

FIGS. 31A-31B are sectional views of a body portion showing the medicaldevice of FIG. 27 excising the uterus during an LSH procedure.

FIGS. 31C-31D are sectional views of a body portion showing the medicaldevice of FIG. 27 performing a conoscopy of cervical tissue.

FIGS. 32A-32D illustrate a method for performing LSH and conizationprocedures.

FIGS. 33A-33B depict an embodiment of a cutting device in retracted anddeployed positions, respectively.

FIGS. 34A-34B are perspective views of another embodiment of a cuttingdevice for performing a conization procedure.

FIGS. 35A-35B depict another embodiment of a cutting device forperforming a conization procedure, in retracted and deployed positions,respectively.

DESCRIPTION OF THE EMBODIMENTS

Reference will now be made in detail to exemplary embodiments of thepresent disclosure, examples of which are illustrated in theaccompanying drawings. Wherever possible, the same reference numberswill be used throughout the drawings to refer to the same or like parts.

Embodiments of the present disclosure generally relate to medicaldevices and methods for performing female pelvic surgical procedures,which may include, but are not limited to, removing a body organ such asa uterus or other structure associated with a reproductive system. Moreparticularly, embodiments of the present disclosure relate to devicesand methods for performing total laparoscopic hysterectomy (TLH) andlaparoscopic supracervical hysterectomy (LSH) procedures. It should beemphasized, however, that the embodiments of the present disclosure mayalso be utilized in abdominal hysterectomies and other female pelvicsurgical procedures. Furthermore, at least the devices disclosed hereinmay be used in the removal of other organs in both males and females.

FIG. 1 illustrates a medical device 10 for performing a TLH procedure,in accordance with a first embodiment of the present disclosure. Medicaldevice 10 may include an elongate member 12, an end effector assembly16, and a handle portion 14. For purposes of this disclosure, “proximal”refers to the end closer to the device operator during use, and “distal”refers to the end further from the device operator during use. Endeffector assembly 16 may be disposed at a distal end portion 12 b ofelongate member 12, and handle portion 14 may be disposed at a proximalend portion 12 a of elongate member 12.

Elongate member 12 may be a unitary hollow structure, including, but notlimited to, a curved tube made from any known suitable biocompatiblematerial having sufficient flexibility and/or rigidity to traverse avaginal canal. Alternatively, elongate member 12 may include two halves13, 15 (FIG. 3 ) that may be connected by welding, soldering, or anyother connection means known to those skilled in the art. Biocompatiblematerials may include, but are not limited to, rubber, silicon,synthetic plastics, stainless steel, ePTFE, PTFE, metal-polymercomposites, and metal alloys of nickel, titanium, copper cobalt,vanadium, chromium, and iron. In one embodiment, the material formingelongate member 12 may be a superelastic material such as nitinol, whichis a nickel-titanium alloy.

Elongate member 12 may have any desired cross-sectional shape anddesired dimension, so long as it may be received in a vaginal canal.Elongate member 12 may also have an atraumatic exterior configuration.Such exterior configurations may include, but are not limited to, arounded external surface. In addition, elongate member 12 may have anysuitable coating such as, for example, an anesthetic or lubriciouscoating on an exterior surface of elongate member 12. Elongate member 12may further include one or more lumens or internal channels (not shown)for the passage of a variety of surgical equipment, including, but notlimited to, imaging devices and tools for irrigation, insufflation,vacuum suctioning, biopsies, and drug delivery. In one embodiment,medical device 10 may also include multiple openings 33, 35 in itsexterior surface. The openings 33, 35 may be connected to the one ormore lumens/channels in elongate member 12, which may be used as anentrance/exit location for an electrical line 36 providing electricalcurrent to medical device 10 or for expansion lines 32, 34 providing anexpansion source to expandable members 18, 26.

End effector assembly 16 may extend distally from distal end portion 12b of elongate member 12. End effector assembly 16 may be made integrallywith elongate member 12. Alternatively, end effector assembly 16 may bea separate portion rigidly secured to elongate member 12 through anyconnection means known to those skilled in the art. Such connectionmeans may include, but are not limited to, welding and soldering. Anadvantage of having end effector assembly 16 being a separate portionfrom elongate member 12 includes ease of sterilizing end effectorassembly 16 after use. End effector assembly 16 may be re-usable ordisposable. A disconnectable end effector assembly 16 may also allow fora device operator to have multiple end effector assemblies 16 in avariety of dimensions, such that the device operator can choose anappropriately sized end effector assembly 16 based on a patient'sanatomy.

End effector assembly 16 may include multiple components, including, butnot limited to, a cup 28, a manipulation device 24, and a cutting device30. End effector assembly 16 may also have suitable illumination andimaging devices (not shown). The illumination device may be used toilluminate and help demarcation of the bladder and vasculature. Cup 28may have any suitable shape and/or configuration, and may be any desireddimension such that it may be received in a patient's vaginal cavity. Inthe embodiment illustrated in FIG. 1 , cup 28 may include a roundedperimeter forming a circular or oval shape.

Cup 28 may also include a substantially conical shape that tapers intoan enlarged edge 28 a. Enlarged edge 28 a may have any suitableatraumatic configuration. For example, edge 28 a may be rounded. Edge 28a may also have a textured geometry or other geometric configuration(e.g., tines, barbs, etc.) to aid in frictionally gripping patienttissue to maintain desired placement of medical device 10. An exteriorsurface of cup 28 may have an atraumatic configuration like that of theexterior surface of elongate member 12. Such atraumatic configurationsmay include, but are not limited to, a smoothed material surface. Inaddition, portions of cup 28 may include any suitable coating,including, but not limited to, an anesthetic or lubricious coating on anexterior of cup 28.

FIG. 4A illustrates an embodiment of cup 28. Cup 28 may include an innercup portion 28 c positioned within an outer cup portion 28 b. There maybe enough space between inner cup portion 28 c and outer cup portion 28b to allow cutting device 30 to move between the directions indicated byarrow 43 (FIG. 1 ) and rotated along the directions indicated by arrow45 (FIG. 2B). Cup 28 may also include a sealing mechanism 31, throughwhich cutting device 30 may protrude, to keep unwanted material (e.g.,tissue or blood) from entering a space between inner cup portion 28 cand outer cup portion 28 b. Sealing mechanism 31 may also limit the backand forth (e.g., lateral) motion of cutting device 30 within the space,so as to avoid potential wandering of cutting device 30 as cuttingdevice 30 is moved along the directions indicated by arrow 45. In oneembodiment, sealing mechanism 31 may include a strip of elastomericmaterial that engages a portion of cutting member 30. Although FIG. 4Ashows a single sealing mechanism 31, those of ordinary skill in the artwill understand that any suitable number of sealing mechanisms 31 may beprovided. For example, a second sealing mechanism may be disposed oninner cup portion 28 c.

Cutting device 30 may be configured to move relative to edge 28 abetween a retracted position shown in FIG. 2A and a deployed positionshown in FIG. 2B along the directions shown by arrow 43 (FIG. 1 ).Movement between the deployed and retracted positions may beaccomplished via a first actuating mechanism 22. In one embodiment,first actuating mechanism 22 may be a slide actuator 38 connected to aproximal end of a first rod 46 within elongate member 12. First rod 46may be operatively connected to cutting device 30 at its distal end viacoupling member 54 and gear 52, as shown in FIG. 3 . Accordingly, axialmovement of first actuating mechanism 22 in the directions indicated byarrow 39 may cause axial movement of cutting device 30 in the directionsindicated by arrow 43. It is contemplated, however, that first actuatingmechanism 22 may be a button or any other actuating mechanism known toone skilled in the art for controlled deployment of cutting device 30.First actuating mechanism 22 may also include a stop 56 within medicaldevice 10 for preventing cutting device 30 from being deployed beyond adesired distance. First actuating mechanism 22 may also include aratcheting detent or locking mechanism to maintain cutting device 30 atits desired deployed or retracted orientations.

Cutting device 30 may also be configured to move along edge 28 a aboutcup 28 in the direction shown by arrow 45. It is shown in FIGS. 1-3 thathandle portion 14 may extend from proximal end portion 12 a of elongatemember 12. Handle portion 14 may include ergonomic and/or geometricstructures that may assist a device operator with gripping medicaldevice 10. For example, in some embodiments, handle portion 14 mayinclude finger grips. Handle portion 14 may also include a secondactuating mechanism 20. Rotational movement of cutting device 30 may beaccomplished via second actuating mechanism 20. Second actuatingmechanism 20 may be any actuating mechanism known to one skilled in theart for controlling rotation of cutting device 30. For example, secondactuation mechanism 20 may be configured to rotate relative to elongatemember 12. Rotation of second actuating mechanism 20 may cause rotationof a rod 48 within elongate member 12. Rod 48 may be attached to secondactuating mechanism 20 at one end (e.g., the proximal end) and to a gearmechanism 50, 52 at its other end (e.g., the distal end). Gear mechanism50, 52 may also be operatively connected to cutting device 30.Accordingly, rotational movement of second actuation mechanism 20 in thedirections indicated by arrow 41 may cause rotational movement ofcutting device 30 in the directions indicated by arrow 45. Secondactuating mechanism 20 may also include a ratcheting detent or lockingmechanism to maintain cutting device 30 in a desired orientation orlocation, if necessary.

Cutting device 30 may be any known cutting device, including, but notlimited to, cautery blades, radio-frequency (RF) devices, cryoablationcatheters, lasers, cautery forceps/scissors, microwave probes, sharpenedblades, and/or ultrasonic ablation devices. In one embodiment, cuttingdevice 30 may be an electrocautery device connected through electricalline 36 to an energy source 712 (FIG. 5C) such as, for example, an RFgenerator. Cutting device 30 may be monopolar, as illustrated in FIG.5C, or bipolar. In monopolar embodiments, for example, medical device 10may further include a grounding pad 37 for placement under the patient,as is well known in the art. In bipolar embodiments, cutting device 30may include two opposing, coacting components that serve to complete thecautery circuit.

In monopolar embodiments, one or more surfaces of cutting device 30 maybe coated with a suitable coating. In one embodiment, the coating may bea dielectric coating. The electrical properties of the coating may bechosen to maximize the flow of electrical cutting current flowing from aleading edge of cutting device 30 while minimizing total current flowthrough the patient. For example, one or more surfaces of cutting device30 may be coated with a material that increases the electricalresistance to the flow of current from the one or more surfaces ofcutting device 30 while other portions (e.g., edges) of cutting device30 may remain uncoated. Suitable coating materials may include, but arenot limited, to rubber, silicone, and plastics such as PTFE.

FIGS. 4B and 4C illustrate alternative embodiments of cutting device 30.For example, cutting device 30 may be a ring 130 or substantiallyring-like 230. The ring may be a single continuous ring 130 that isdeployable/retractable as one, unitary portion; or ring 230 may containmultiple segmented sections 230 a-f. Segmented sections 230 a-f may beformed by overmolding a continuous ring with plastic or other insulatingmaterial to form exposed, segmented sections 230 a-f. In suchembodiments, ring 230 may be connected to an electrode. Alternatively,each segmented section 230 a-f may be discrete and attached toindividual wires 232 a-f through a switch 234 to an electrosurgicalgenerator, such that each segment 230 a-f may be deployed independentlyand/or each segment 230 a-f may be selectively turned on, if eachsegment is deployed at the same time, using switch 234 as a selector.Further, a computer (not shown) may be in communication with segmentedsections 230 a-f for selectively controlling deployment, rotation, andactuation of each segmented section 230 a-f. Accordingly, switch 234 maybe a microcontroller capable of executing a software control program.

Manipulation device 24 may be fixed to cup 28 and extend distally fromcup 28. In some embodiments, manipulation device 24 may be integral withcup 28. In other embodiments, however, manipulation device 24 may beremovably coupled to cup 28. In still other embodiments, manipulationdevice 24 may be slidably disposed in relation to cup 28. Manipulationdevice 24 may be a malleable or flexible elongate member made from anysuitable biocompatible material known to one of ordinary skill in theart having sufficient flexibility to traverse vaginal and uterinecavities.

Manipulation device 24 may have any desired cross-sectional shape and/orconfiguration, and may be any desired dimension that can be receivedwithin the vaginal and uterine cavities. For example, manipulationdevice 24 may be a hollow structure with one or more lumens or channels(not shown) providing a passage for surgical equipment. Surgicalequipment may include, but is not limited to, optical scopes,illumination devices, and/or tools for irrigation, insufflation,biopsies, vacuum suctioning, closure of the vaginal cuff and/or drugdelivery. Manipulation device 24 may further have an atraumaticconfiguration on its distal end portion and exterior surface. Suchexterior configurations may include, but are not limited to, a smoothed,rounded surface. In addition, manipulation device 24 may include anysuitable coating, such as an anesthetic, antibacterial, or lubriciouscoating.

At least one expandable member may be disposed on an exterior surface ofmedical device 10. In one embodiment, as shown in FIG. 1 , first andsecond expandable members 18, 26 may be disposed on exterior surfaces ofelongate member 12 and manipulation device 24, respectively. Firstexpandable member 18 may be an occluder in the form of a vaginal dam inorder to prevent passage alongside of medical device 10. For example,during a hysterectomy procedure, the abdomen may be inflated with gas tocreate space for visualization and uterine movement, and firstexpandable member 18 may prevent that gas from prematurely escapingduring a hysterectomy procedure. Second expandable member 26 may be usedto retain medical device 10 in a desired location within a uterinecavity. For example, second expandable member 26 may serve to securemanipulation device 24 relative to a uterus when the uterus is removedtransvaginally during a TLH procedure.

The phrase “expandable member” generally relates to any expandablestructure, including inflatable structures, mechanically expandablestructures, and deformable structures, such as foamed rubbers. In oneembodiment, expandable members 18, 26 may be inflatable balloons withany degree of elasticity, so long as they are capable of inflation to adesired dimension to maintain the position of medical device 10 withinthe vaginal and uterine cavities. Expandable members 18, 26 may bethin-walled structures made of material of low elasticity (which doesnot stretch significantly during inflation) or highly elastic material(which does stretch significantly during inflation). Expandable members18, 26 may also be made from polyethylene terephthalate (PET),polyurethanes, polyethylenes and ionomers, copolyesters, rubbers,polyamides, silicone, latex, or any other suitable materials known inthe art.

Expandable members 18, 26 may be fluidly connected to fluid sources viaexpansion lines. For example, first and second expandable members 18, 26may be connected via first and second expansion lines 32, 34 to fluidsources such as, for example, saline. Fluid source connections may allowfor inflation of expandable members 18, 26 from a collapsedconfiguration to an expanded configuration. Fluid sources may also allowfor deflation of expandable members 18, 26 from an expandedconfiguration to a collapsed configuration. Expandable members 18, 26may additionally include sensors and indicators to monitor variousproperties during inflation and deflation, including, but not limitedto, safety features, such as a pressure limiting valve and/or a pressuresensor to monitor the force expandable members 18, 26 may exert on apatient's vaginal and uterine cavities. Expandable members 18, 26 mayalso include radiopaque and/or sonoreflective markers so that one couldvisualize and monitor the expansion of expandable members 18, 26.

Alternatively, expandable members 18, 26 may be mechanically expandablemembers, including, but not limited to, cages, foams, and stents. Inembodiments with mechanically expandable members 18, 26, expansion lines32, 34 may be substituted for control lines leading to mechanicalactuating and retracting means for selectively expanding and collapsingexpandable members 18, 26. For example, mechanical actuating andretracting means may include retractable covers, biodegradable sleeves,motor attachments, or any other suitable actuating means known to thoseskilled in the art. Mechanical expandable members 18, 26 may also beprovided with sensors, indicators, or radiopaque and/or sonoreflectivemarkers to monitor properties during expansion and retraction ofexpandable members 18, 26 within vaginal and uterine cavities.

Turning now to FIGS. 5A-5C, 6, 7A-7B, 8A-8B, and 9A-9C in the presentdisclosure, there is illustrated an embodiment of a method forperforming a TLH procedure. The patient may be prepared for the surgeryaccording to procedures that are well known in the surgical arts. Forexample, patient 710 may be oriented in a supine-lithotomy configurationon operating table 700, such that patient 710's legs may rest in raisedstirrups 709. Alongside operating table 700, a surgeon 704, ananesthesiologist 703, and a medical assistant 708 may be present. Othersuitable personnel 701 may be present as well. Additionally, theoperating room may be provided with equipment to assist in the surgery,including, but not limited to, monitors 706, a foot switch 705, anelectrosurgical generator 702, and an instrument table 707. Thepersonnel and equipment may be arranged in any desired order and/orconfiguration.

Once patient 710 is prepared, medical device 10 is inserted into thevaginal and uterine cavities, and the first and second expandablemembers 18, 26 (FIG. 7B) are expanded to abut tissue in the vaginal anduterine cavities in order to properly position medical device 10 andfacilitate occlusion in the vaginal cavity. The abdominal cavity 710 amay then be insufflated to create space and facilitate accessibility andvisibility of the female pelvic organs. Multiple laparoscopic incisions711 may further be cut in the patient's abdomen area to facilitate theintroduction of surgical instruments. As shown in FIG. 5C, prior toinsertion of medical device 10, cutting device 30 may be connectedthrough an electrical line 36 to an energy source 712 such as, forexample, a radio-frequency (RF) or electrosurgical generator.

Turning now to FIGS. 6 and 7A-7B, surgical instruments 502, 506, 507 maybe inserted through incisions 711 in order to, for example, facilitatecutting of ligamentus structures 503 and/or to illuminate/visualizeareas of interest. In some embodiments, medical device 10 may beinserted into a vaginal cavity and advanced to uterus 500 after surgicalinstruments 502, 506, 507 have been inserted into the patient 710, orone or more preparation steps have been completed. Further, manipulationdevice 24 of medical 10 may be positioned to extend into the uterinecavity. Once end effector assembly 16 of medical device 10 has beeninserted into the vaginal and uterine cavities, expandable members 18,26 may be expanded from a collapsed configuration to an expandedconfiguration via expansion lines 32, 34, or any other means discussedin the present disclosure.

Manipulation device 24 may be at least partially positioned within theuterus 500, and cup 28 may engage vaginal fornices 508, as shown in FIG.8A. FIG. 8B illustrates that a device operator may then apply a cephaladforce to medical device 10 in the direction of arrow 509, allowing cup28 to tent vaginal fornices 508, thereby preparing uterus 500 forcutting/excision.

As illustrated in FIGS. 9A-9C, a device operator may then actuate firstactuating mechanism 22 in the direction of arrow 39 to advance cuttingdevice 30 from a retracted position to a deployed position, which maycreate an incision in vaginal fornix tissue. Second actuating mechanism20 may be rotated along the direction of arrow 41 relative to elongatemember 12 to move cutting device 30 along edge 28 a of cup 28. In thismanner, cutting device 30 may create a substantially rounded, uniformcolpotomy incision to separate uterus 500, along with the cervix, fromthe vaginal apex. Upon completion of uterine and cervical excision, thevaginal cuff opening left behind may be closed using means known tothose skilled in the art, including, but not limited to, sutures,staples, and/or glue. Additionally, uterus 500 may be removed by anysuitable means known in the art. In some embodiments, additional toolsand/or equipment may be used to, for example, cut uterine tissue intosmall pieces for extraction. One example of such a tool may include amorcellator. In addition, or alternatively, a suctioning device may beused to remove the entire uterus or any of its portions.

FIG. 10 illustrates a further embodiment of a medical device 100 forperforming a TLH procedure. Medical device 100 may include one or morefeatures of medical device 10 of FIG. 1 . For example, medical device100 may include an elongate member 120, an end effector assembly 160, ahandle portion 140, and expandable members 180, 260. Substantively,elongate member 120 may be similar to elongate member 12 of FIG. 1 .

End effector assembly 160 may be pivotally secured to distal end 120 bof elongate member 120, such that it may pivot between a first position279 and a second position 281 along a first pivotal path 283.Additionally, handle portion 140 may be pivotally secured to a proximalend 120 a of elongate member 120, such that it may pivot between a firstposition 199 and a second position 201 along a second pivotal path 203.Movement of end effector assembly 160 between its first and secondpositions 279, 281 may be controlled by movement of handle portion 140.Additionally, end effector assembly 160 and handle portion 140 may eachbe secured to elongate member 120 via any type of pivot mechanism knownto those skilled in the art. For example, in one embodiment, endeffector assembly 160 and handle portion 140 may each be secured toelongate member 120 via a hinge 224, which may include a pivot pin.

End effector assembly 160 may be a separately connected portion toelongate member 120 and may be reusable or disposable. End effectorassembly 160 may also be produced in a variety of dimensions toaccommodate a variety of patient anatomies.

End effector assembly 160 may include multiple components, including,but not limited to, a cup 280, a manipulation device 240, and a cuttingdevice 330. Manipulation device 240 may be substantively similar tomanipulation device 24 of FIG. 1 . However, manipulation device 240 maybe configured to rotate relative to elongate member 120, as shown inFIG. 10 . Cup 280 may include one of more of the features of cup 28 ofFIG. 1 . For example, cup 280 may have an enlarged edge 280 a that isatraumatic and/or textured to aid in gripping a cervix to maintaindesired placement of medical device 100. Cup 280 may also have anatraumatic exterior surface 280 b with a coating affixed thereto. Cup280 may also be configured to rotate relative to elongate member 120.

Cup 280 may have any shape and/or configuration, and may be any desireddimension such that it can be received in a patient's vaginal cavity.FIGS. 12A and 12B illustrate that cup 280 may include an inner cupportion 280 c and an outer cup portion 280 b. Inner cup portion 280 cmay have a bottom surface that is spaced from a lower surface of outercup portion 280 b. Inner and outer cup portions 280 c, 280 b may includethrough-openings in outer surfaces of each portion. Alternatively, innerand outer cup portions 280 c, 280 b may be solid pieces with nothrough-openings.

Cup 280 may also include a cutting device 330 located in recess 310(FIG. 10 ) and a cutting device carrier 254 located in a space betweenan outer, bottom surface of inner cup portion 280 c and an inner surfaceof outer cup portion 280 b. A control rod 242 may be connected tocutting device carrier 254 and to a first actuating mechanism 220 withinhandle portion 140. First actuating mechanism 220 may be any actuatingmechanism capable of creating axial motion. Such actuating mechanismsmay include, but are not limited to, a slide actuator or push button. Inone embodiment, first actuating mechanism 220 may be a thumbwheel.Rotation of thumbwheel 220 may cause cutting device carrier 254 to movewithin the space between inner cup portion 280 c and outer cup portion280 b, thereby causing movement of cutting device 330 between retractedand deployed configurations in the directions shown by arrow 335, asshown in FIGS. 11 and 12A-12B.

With reference to FIG. 11 , cutting device 330 may also be configured torotate about cup 280 in the direction of arrow 331 due to operation ofsecond actuating mechanism 200. Second actuating mechanism 200 may beany actuating mechanism known to one skilled in the art that providesrotation of cutting device 330. For example, second actuating mechanism200 may be configured to rotate relative to elongate member 120 in thedirection of arrow 205. Control rods 242, 244 may be connected to secondactuating mechanism 200 such that rotation of second actuating mechanism200 may cause control rods 242, 244 to transfer rotational force tocutting device 330. Alternatively, second actuating mechanism 200 may beconfigured to transfer rotational force to cup 280, such that cup 280and cutting device 330 rotate together.

Each of first and second actuating mechanisms 220, 200 may also comprisea ratcheting detent or a locking mechanism to maintain cutting device330 in any desired orientation.

Cutting device 330 may include one or more of the features of cuttingdevice 30 of FIG. 1 . For example, cutting device 330 may be any cuttingdevice known to those skilled in the art, including an electrocauterydevice connected through an electrical line 360 to an energy source(e.g., an electrosurgical generator). Electrical line 360 may beconnected to cutting device 330 via an exterior opening 361. Cuttingdevice 330 may also comprise one of the ring-shaped configurations 130,230 illustrated in FIGS. 4B and 4C. In one embodiment, cutting device330 may be made of a flexible material such that it may project out to adesired cutting angle when deployed, as illustrated in FIGS. 12A and12B. The desired cutting angle may be formed between an inner surface ofouter cup portion 280 b and an outer surface of inner cup portion 280 c.In one embodiment, the desired cutting angle may be betweenapproximately 10 and 45 degrees and preferably approximately 15 degrees;however, the cutting angle may be any value that accomplishes a TLHprocedure.

As shown in FIG. 11 , medical device 100 may also include at least oneexpandable member on elongate member 120 and/or manipulation device 240.Expandable members 180, 260 may be substantively similar to expandablemembers 18, 26 of FIG. 1 . For example, first and second expandablemembers 180, 260 may be connected to first and second expansion sourcelines 320, 340. First and second expansion source lines 320, 340 may beconnected to a lumen or channel (not shown) in medical device 100 viaexterior openings 341.

FIG. 13 illustrates another embodiment of medical device 300 forperforming TLH procedures. Medical device 300 may include one or morefeatures of medical device 100 in FIG. 10 . For example, medical device300 may include the same features of cup 280 and manipulation device 240as illustrated in medical device 100 shown in FIG. 10 .

Medical device 300 may also include an elongate member 301, an endeffector assembly 246, and a handle portion 302. Elongate member 301 mayinclude one or more features of elongate member 120 in FIG. 10 . Inaddition, or alternatively, elongate member 301 may be a hollowstructure including a mechanical system of gears and belts as analternative to the control rod 242 system discussed above. Gears andbelts may include, but are not limited to, slot gears 325, toothed gears304, and toothed belts 321, 322. Handle portion 302 may be pivotallysecured to elongate member 301 at its proximal end 301 a. Handle portion302 may be rotated about a pivot rod 306 in the direction shown by arrow319. End effector assembly 246 may be pivotally secured to elongatemember 301 at its distal end 301 b via pivot rod 310. Movement of handleportion 302 in the direction of arrow 319 may cause movement of endeffector assembly 246 in the direction of arrow 313.

Further, movement of a first actuating mechanism 312 in the direction ofarrow 315 may cause deployment of cutting device 330 via a series ofindependent translational and rotational movements. Translationalmovement of first actuating mechanism 312 may cause rotational movementof gears A and C and one of toothed belts 321, 322. Rotational movementof gears A and C and one of toothed belts 321, 322 may then causetranslational movement in end effector assembly 246, resulting indeployment of cutting device 330. Similarly, rotational movement ofsecond actuating mechanism 314 in the direction shown by arrow 317 maycause rotation of cutting device 330 via a series of independentrotational movements.

FIGS. 14A and 14B of the present disclosure illustrate an embodiment ofa method for performing a TLH procedure using medical device 100 of FIG.10 . Alternatively, medical device 300 of FIG. 13 may be used for theTLH procedure in place of medical device 100 of FIG. 10 . The methodillustrated in FIGS. 14A and 14B follows the same preparation steps asthe method illustrated in FIGS. 5A-5C, 6, and 7A-7B. After expandablemembers 180, 260 have been expanded such that they abut tissue in thevaginal and uterine cavities, a device operator may rotate handleportion 140 in the directions of arrow 203. Rotation of handle portion140 may cause manipulation device 240 to move uterus 500 in the cephaladdirections shown by arrow 283 and may cause cup 280 to tent vaginalfornices 508, placing uterus 500 in a desired excisional orientation.Cutting device 330 may then be deployed and rotated via the use of firstand second actuating mechanisms 220, 200 in order to create a uniform,rounded colpotomy incision to separate uterus 500, along with thecervix, from the vaginal apex. Upon completion of uterine and cervicalexcision, the vaginal cuff opening left behind may be sutured orotherwise closed as known to those skilled in the art.

FIG. 15 illustrates another medical device 1000 for performing a TLHprocedure, in accordance with a fourth embodiment of the presentdisclosure. Medical device 1000 may include one or more of the featuresof any of the other embodiments disclosed herein. For example, medicaldevice 1000 may include a first elongate member 1020 and a secondelongate member (collectively referred to as “1020 a-b”) disposedtherein. The second elongate member 1020 a-b may include two halves 1020a, 1020 b. First and second elongate members 1020, 1020 a-b may behollow, tubular structures and may have any cross-sectional shape anddesired dimension, so long as they may be received in a vaginal canal.First elongate member 1020 may be a unitary structure. The secondelongate member 1020 a-b may also be a unitary structure. Alternatively,as noted above, the second elongate member 1020 a-b may include twohalves 1020 a, 1020 b, as shown in FIG. 16 . Halves 1020 a, 1020 b maybe connected via welding, soldering, or any other connection means knownto those skilled in the art. Elongate members 1020, 1020 a-b may alsoinclude an atraumatic exterior surface with an affixed coating like theexterior surface of elongate member 12 in FIG. 1 . Second elongatemember 1020 a-b may be coaxially disposed within a central lumen offirst elongate member 1020. In some embodiments, second elongate member1020 a-b may be rotationally and/or axially movable within firstelongate member 1020.

First and second elongate members 1020, 1020 a-b may also include one ormore lumens or channels 1010, respectively, with the lumens potentiallyproviding passage for a variety of surgical equipment. In oneembodiment, medical device 1000 may include an opening 1150 in anexterior surface. Opening 1150 may be in communication with centrallumen or channel 1010 for receiving an electrical line 1140 to power acutting device 1130. Although the depicted embodiment illustratesopening 1150 disposed on control member 1030, opening 1150 may bedisposed on any suitable external surface of elongate member 1020.Medical device 1000 may further include a cover 1024 at a proximal endof first and second elongate members 1020, 1020 a-b such that cover 1024may act as a seal. Cover 1024 may also include an opening therethrough,facilitating insertion of surgical equipment through the one or morelumens or channels 1010 in medical device 1000.

Second elongate member 1020 a-b may include an atraumatic distal end1280, which may further comprise suitable geometric configurations toaid in maintaining medical device 1000 in a desired location within apatient. In one embodiment, distal end 1280 may be tapered to provide anangled cutting plane. Medical device 1000 may also include at least oneexpandable member 1080 along with an expansion source line 1120connected to expandable member 1080. Although the depicted embodimentillustrates expandable member 1080 being closer to distal end 1280,expandable member 1080 may be positioned anywhere along the length ofmedical device 1000.

A cutting device 1130 may be disposed within medical device 1000 betweenhalves 1020 a, 1020 b of second elongate member 1020 a-b. In oneembodiment, cutting device 1130 may be movable between a retractedposition and a deployed position, in which cutting device 1130 extendsdistally beyond distal end 1280 of second elongate member 1020 a-b.Although the depicted embodiment illustrates cutting device 1130extending straight out of medical device 1000, cutting device 1130 mayextend at any suitable angle. Cutting device 1130 may be operativelyconnected to a first control rod 1200, which may extend to a proximalend of medical device 1000. As shown in FIG. 16 , for example, firstcontrol rod 1200 may be connected to cutting device 1130 by a secondcontrol rod 1202. First and second control rods 1200, 1202 may beseparate rods or a unitary piece, such that first control rod 1200 maybe offset from second control rod 1202.

Medical device 1000 may further include a handle portion 1040,including, but not limited to, a gripping member 1028 and a controlmember 1030. Additionally, first control rod 1200 may extend proximallyfrom handle portion 1040. In use, a device operator may maintain firstelongate member 1020 and handle portion 1040 in a fixed position whenpositioning medical device 1000 against a patient's vaginal fornices508. The device operator may manipulate first control rod 1200 to movecutting device 1130 axially along an axis that is parallel to alongitudinal axis of medical device 1000. The device operator may thenrotate control member 1030, which may cause cutting device 1130 torotate in the same direction as control member 1030.

FIGS. 17A and 17B of the present disclosure illustrate a method forperforming a TLH procedure using medical device 1000 shown in FIG. 15 .The method illustrated in FIGS. 17A and 17B follows the same preparationsteps as the method illustrated in FIGS. 5A-5C, 6, and 7A-7B. Afterinsertion of medical device 1000 into a vaginal cavity, distal end 1280of medical device 1000 may engage one or more vaginal fornices 508.Surgical equipment may also be inserted through a central lumen 1010 ofmedical device 1000 to aid in the procedure. In one embodiment,expandable member 1080 may be expanded such that it abuts tissue in avaginal cavity and acts as an occluder, so as to prevent inflation gasesfrom prematurely escaping from the patient's abdomen. Second control rod1202 and cutting device 1130 are located between halves 1020 a, 1020 bof second elongate member 1020 a-b, which further fit within firstelongate member 1020. As previously discussed, a device operator mayextend cutting device 1130 by sliding first control rod 1200 in thedirections of arrow 1203. Upon deployment of cutting device 1130, thedevice operator may then rotate the cutting device 1130 by rotatingcontrol member 1030 in the directions of arrow 1205 relative to firstelongate member 1020 and gripping member 1028 in order to create auniform, rounded incision to excise the uterus 500, along with thecervix, from the vaginal apex. Upon completion of uterine and cervicalexcision, the vaginal cuff opening left behind may then be sutured orotherwise closed as known to those skilled in the art.

FIG. 18 illustrates a medical device 400 for a laparoscopicsupracervical hysterectomy (LSH) procedure, in accordance with a fifthembodiment of the present disclosure. Medical device 400 may include oneor more of the features of medical device 100 illustrated in FIG. 10 .For example, medical device 400 may include an elongate member 120 and ahandle portion 140. Medical device 400 may also include an end effectorassembly 460. End effector assembly 460 may be capable of pivotingbetween a first position 243 and a second position 245 in the directionsof arrow 241 in response to pivotal motion of handle portion 140 betweenits first pivotal position 199 and second pivotal position 201 in thedirections of arrow 203.

End effector assembly 460 may include a manipulation device 440 with acutting device 430 located therein. Cutting device 430 may include oneor more of the features of cutting device 130 described in FIG. 10 .Cutting device 430 may be any cutting device known to those skilled inthe art and may be configured to move relative to manipulation device440 between a deployed position, illustrated in FIG. 19 , and aretracted position, illustrated in FIG. 18 , in the directions of arrow209. In its retracted position (FIG. 20 ), cutting device 430 may bemaintained within a recess 431 in manipulation device 440. Recess 431may be any suitable shape, size, and/or configuration, so long as it maymaintain cutting device 430 therein. For example, in one embodiment,recess 431 may be rectangular. Further, manipulation device 440 mayinclude multiple recesses 431, with each recess 431 maintaining acutting device 430 therein.

Deployment and retraction of cutting device 430 may be controlled by afirst actuating mechanism 220 that may transfer force to cutting device430 via a control rod 242 and a hinge mechanism 250, as illustrated inFIG. 20 . First actuating mechanism 220 and control rod 242 maysubstantively include the features of first actuating mechanism 220 andcontrol rod 242 of medical device 100 shown in FIG. 10 . Hinge mechanism250 may be any type of pivoting mechanism known to those skilled in theart. Hinge mechanism 250 may also be operably connected to cuttingdevice 430 and may include multiple pivot points 434, 436 within recess431. Pivoting movement of hinge mechanism 250 about pivot points 434,436 may cause cutting device 430 to move between its deployed andretracted configurations.

Cutting device 430 may also be configured to rotate with manipulationdevice 440 in the directions of arrow 207 (FIG. 19 ). Rotation ofcutting device 430 may be controlled by a second actuating mechanism200. Second actuating mechanism 200 may be operably connected to cuttingdevice 430 via control rod 242. Second actuating mechanism 200 andcontrol rod 242 may substantively include the features of secondactuating mechanism 200 and control rod 242 of medical device 100 shownin FIG. 10 . For example, rotation of second actuating mechanism 200 inthe directions of arrow 205 may cause control rod 242 to transferrotational force to cutting device 430.

Manipulation device 440 may include one or more features of manipulationdevice 240 shown in FIG. 10 . For example, manipulation device 440 mayinclude an atraumatic exterior with a coating to facilitate insertion ofmedical device 400 into a patient. Manipulation device 440 may alsoinclude one or more lumens for insertion of surgical equipment,including, but not limited to, imaging and illumination devices, suctiondevices, biopsy tools, and drug-delivery mechanisms.

In order to maintain medical device 400 within a patient, manipulationdevice 440 may further include a gripping structure on its exteriorsurface (e.g., tines or barbs). Alternatively, medical device 400 mayinclude expandable members like expandable members 180, 260 illustratedin FIG. 10 of the present disclosure.

FIGS. 21A and 21B illustrate a cross-sectional view of a distal end of amedical device 600 for an LSH procedure, in accordance with a sixthembodiment of the present disclosure. Medical device 600 may include oneor more features of medical device 100 shown in FIG. 10 , medical device300 shown in FIG. 13 , and medical device 400 shown in FIG. 18 . Forexample, medical device 600 may include an elongate member 301 with anend effector assembly 660 at its distal end 301 b. Medical device 600may also include expandable members like expandable members 180, 260illustrated in FIG. 10 of the present disclosure. Further, as discussedin the present disclosure in relation to medical device 300 of FIG. 13 ,end effector assembly 660 may pivot about rod 310 due to movement fromhandle portion 302 in combination with a system of gears and belts.

End effector assembly 660 may include a manipulation device 640 and acutting device 630. Manipulation device 640 may include one or morefeatures of manipulation device 440 shown in FIG. 18 , including, butnot limited to, an atraumatic exterior surface with a coating, one ormore lumens, and a means for maintaining medical device 600 within apatient.

Cutting device 630 may be configured to move between a retractedposition (FIG. 21A) and a deployed position (FIG. 21B). Cutting device630 may be deployed via a plunger 610. Plunger 610 may be part of aratcheting system (FIG. 21A) that is operatively connected to cuttingdevice carrier 650 and cutting device 630. Translational movement of afirst actuating mechanism 312 may cause rotational movement of gears andbelts, which in turn may cause translational movement of plunger 610 andcutting device carrier 650 in the directions of arrow 611, resulting indeployment and retraction of cutting device 630.

Cutting device 630 may be any cutting device known to those skilled inthe art, such that cutting device 630 can be deployed and retractedalong a path that may include linear and/or nonlinear sections (e.g.,flexible blade or laser). Cutting device 630 may also be configured torotate with manipulation device 640 in the directions of arrow 207 inresponse to rotation of a second actuating member 314 in the directionsof arrow 317. Although the depicted embodiment illustrates cuttingdevice 630 deployed at an angle of 90 degrees relative to manipulationdevice 640, cutting device 630 may extend at any suitable angle,preferably approximately between 15 and 90 degrees.

FIGS. 22A and 22B of the present disclosure illustrate a method forperforming an LSH procedure using medical device 400 of FIG. 18 .Alternatively, medical device 600 of FIGS. 21A-21B may be used for theLSH procedure in place of medical device 400 of FIG. 18 . The methodillustrated in FIGS. 22A and 22B follows the same preparation steps asthe method illustrated in FIGS. 5A-5C and 6 . Medical device 400 may bemaintained in a desired position via expandable members or othergripping means. A device operator may rotate handle portion 140 in thedirections of arrow 203. Rotation of handle portion 140 may causemanipulation device 440 to pivot uterus 500 in the directions of arrow241, which may place uterus 500 in a desired cutting orientation.Cutting device 430 may then be deployed and rotated via the use of thefirst and second actuating mechanisms 220, 200 in order to create auniform, rounded incision to excise the uterine fundus 510 from thecervix, which is left in situ. Once uterine fundus 510 is withdrawnusing accepted techniques to those skilled in the art, the vaginal cuffopening left behind is sutured or otherwise closed as known to thoseskilled in the art.

FIG. 23 illustrates another medical device 1300 for performing an LSHprocedure, in accordance with a seventh embodiment of the presentdisclosure. Medical device 1300 may include one or more features of anyof the other embodiments disclosed herein. For example, medical device1300 may include an elongate member 1310, a handle portion 1312, an endeffector assembly 1314, and an expandable member 1318. End effectorassembly 1314 may be disposed at a distal end 1310 b of elongate member1310, and handle portion 1312 may be disposed at a proximal end 1310 aof elongate member 1310.

Substantively, elongate member 1310 may be similar to elongate member 12of FIG. 1 . For example, elongate member 1310 may be a unitary hollowtube having sufficient flexibility to traverse a vaginal canal.Alternatively, elongate member 1310 may include two halves 1310′ (FIG.26 ) that may be connected via any connection means (e.g., welding,soldering, etc.) known to those skilled in the art. Elongate member 1310may be curved along its length and include a proximal end 1310 a and adistal end 1310 b. Proximal end 1310 a may include an opening incommunication with a central lumen 1344 of elongate member 1310. Centrallumen 1344 may also be in communication with an opening 1325 in anexterior surface of elongate member 1310. Opening 1325 in the exteriorsurface of elongate member 1310 may allow for passage of an electricalline 1324 providing electrical current cutting device 1330. Distal end1310 b may include a stop surface 1346 for providing a point beyondwhich, end effector assembly 1314 may not traverse. Further, distal end1310 b may include threads 1338 configured to mate with correspondingthreads 1336 on end effector assembly 1314.

End effector assembly 1314 may extend distally from distal end 1310 b ofelongate member 1310 and may be removably attached to distal end 1310 bby any connection means known to those skilled in the art. For example,as discussed above, in one embodiment, end effector assembly 1314 mayinclude threads 1336 configured to mate with corresponding threads 1338at distal end 1310 b of elongate member 1310. Alternatively, endeffector assembly 1314 may be telescopically connected to distal end1310 b of elongate member 1310, such that a connector portion 1320 ofend effector assembly 1314 may be slidably engaged within central lumen1344 of elongate member 1310. End effector assembly 1314 may be reusableor disposable. Alternatively, end effector assembly 1314 may be integralwith elongate member 1310.

End effector assembly 1314 may include multiple components, including,but not limited to, a connector portion 1320, a manipulation device1322, and a cutting device 1330. Manipulation device 1322 may extendthrough an opening, discussed in greater detail below, in connectorportion 1320 and may be independently movable relative to connectorportion 1320. Manipulation device 1322 may be disposable or reusable andmay have any shape, configuration, and/or dimension, such that it may bereceived in a patient's vaginal cavity. For example, in one embodiment,manipulation device 1322 may include an s-shaped curve along its length.Alternatively, manipulation device 1322 may be substantially straightalong its length, similar to manipulation device 440 of medical device400 shown in FIG. 18 . Manipulation device 1322 may also be a hollowtube with a lumen (not shown) for allowing passage of illumination andimaging devices, as well as tools for suction, irrigation, drugdelivery, and uterine removal and manipulation. Further, manipulationdevice 1322 may have an atraumatic exterior configuration with a roundedsurface and/or an anesthetic or lubricious coating.

Manipulation device 1322 may further include an expandable member (notshown) for securing medical device 1300 relative to a uterus. Theexpandable member may also serve the purpose of tensioning the uterinewall in an area of an incision made by cutting device 1330.Substantively, the expandable member may be similar to expandable member26 of medical device 10 shown in FIG. 1 . For example, the expandablemember may be any suitable expansion means (e.g., balloon, cage, foam,etc.), and may be expanded via an expansion line (not shown), which mayrun through an opening similar to opening 1325 in the exterior surfaceof elongate member 1310.

Connector portion 1320 may be a hollow, cap-like structure having anopening configured to receive distal end 1310 b of elongate member 1310.As discussed above, a distal end-face of connector portion 1320 mayinclude an opening through which manipulation device 1322 may pass.Connector portion 1320 may have a textured gripping portion on anexterior surface (FIG. 23 ) for allowing a device operator to rotate endeffector assembly 1314 in the directions shown by arrow 1315. Rotationof connector portion 1320 in the directions shown by arrow 1315 may, asa result of the connection between threads 1336, 1338, result intranslational movement of end effector assembly 1314 in the directionsshown by arrow 1325. As discussed above, connector portion 1320 mayfurther be telescopically connected to distal end 1310 b of elongatemember 1310, such that it may move in the directions shown by arrow 1325relative to elongate member 1310 (FIG. 31C). Connector portion 1320 mayalso include a locking mechanism (not shown) in order to maintain adesired relationship relative to elongate member 1310. In additionalembodiments, a distal end of connector portion 1320 may includeintegrated visualization devices, such as, e.g., light sources or lightguide tubes and/or cameras. Furthermore, such embodiments may beconfigured to deliver irrigation and/or suction to the surgical site.

Connector portion 1320 may be any shape and/or configuration, such thatit may be received in a patient's vaginal cavity. For example, in oneembodiment, connector portion 1320 may be a cup with an enclosed edgefor engaging vaginal fornices (FIGS. 32A-32D). Further, connectorportion 1320 may have any suitable atraumatic configuration at itsdistal end, including, but not limited to, a rounded exterior surface.Connector portion 1320 may also include a textured geometry on itsexterior surface for frictionally gripping patient tissue to aid inmaintaining desired placement of medical device 1300.

Medical device 1300 may further include handle portion 1312 extendingproximally from proximal end 1310 a of elongate member 1310. Handleportion 1312 may include a gripping portion 1316 and a telescopingportion 1317. Telescoping portion 1317 may be an elongate structurehaving a diameter that is less than the diameter of the opening atproximal end 1310 a of elongate member 1310, thereby allowingtelescoping portion 1317 to slide within central lumen 1344 of elongatemember 1310 in the directions shown by arrow 1313. Gripping portion 1316may extend proximally from telescoping portion 1317 and may include atextured surface for aiding a device operator with manipulation ofhandle portion 1312. In addition to telescopic movement, handle portion1312 may be rotated relative to elongate member 1310 in the directionsshown by arrow 1311.

Movement of handle portion 1312 relative to elongate member 1310 maycontrol movement of cutting device 1330. For example, as illustrated inFIG. 24A, the device operator may move handle portion 1312 in thedirections of arrow 1313 to move cutting device 1330 in the direction ofarrow 1319 between a deployed position and a retracted position.Further, as illustrated in FIG. 24B, the device operator may rotatehandle portion 1312 in the directions of arrow 1311 to rotate cuttingdevice 1330 in the directions of arrow 1321. Although cutting device1330 is illustrated as being deployed perpendicularly to manipulationdevice 1322, cutting device 1330 may be deployed at any suitable angle.For example, a suitable deployment angle from manipulation device 1322may be anywhere in the range of approximately 15 degrees to 90 degrees,and preferably approximately 45 degrees. Accordingly, handle portion1312 may include features (e.g., markings) to indicate the deployedand/or rotational positions of cutting device 1330 relative to, e.g.,the central axis of manipulation device 1322.

As illustrated in FIGS. 25 and 26 , medical device 1300 may furtherinclude multiple components within central lumen 1344 of elongate member1310 that are operably connected to handle portion 1312 for controllingmovement of cutting device 1330. For example, telescoping portion 1317may include a first rod 1342 that may be operably connected to a firstend 1339 of a plunger 1340. A second end 1341 of plunger 1340 may beoperably connected to a second rod 1334, which may be pivotallyconnected by pins 1335 to cutting device 1330. Bearings 1332 may supportand aid rotation of manipulation device 1322 in the directions of arrow1321. Bearings 1332 may further provide a stop surface for plunger 1340,such that second end 1341 of plunger 1340 may not move beyond thatpoint. In use, movement of handle portion 1312 in the directions shownby arrow 1313 may cause first rod 1342 to act on plunger 1340, which inturn may cause second rod 1334 to move within a lumen in a proximal end1331 of manipulation device 1322 and pivot cutting device 1330 in thedirection shown by arrow 1319 into a deployed configuration. Further,rotation of handle portion 1312 in the directions of arrow 1311 maycause first rod 1342 to act on plunger 1340, which may operably act onproximal end 1331 of manipulation device 1322, causing rotation ofmanipulation device 1322 with cutting device 1330.

Cutting device 1330 may be any known cutting device to those skilled inthe art, including, but not limited to, radio-frequency (RF) devices,lasers, microwave probes, and/or ultrasonic ablation devices. Asillustrated in FIG. 25 , cutting device 1330 may also be a flexiblecautery blade configured to conform the curvature of manipulation device1322 when cutting device 1330 is in a retracted position withinmanipulation device 1322. Alternatively, cutting device 1330 may be asubstantially flat and/or rigid blade, similar to cutting device 430 ofmedical device 400 shown in FIG. 19 . As discussed above, cutting device1330 may be connected to electrical line 1324, and electrical line 1324may further extend through opening 1325 in the exterior surface ofelongate member 1310, thereby allowing for a connection to an externalenergy source (not shown). FIG. 25 also depicts a single cutting device1330 in a retracted position within manipulation device 1322.Alternatively, medical device 1300 may include multiple cutting devices1330 circumferentially spaced around manipulation device 1322, such thateach cutting device 1330 may be independently deployed. In embodimentswith multiple cutting devices 1330, it is contemplated that cuttingdevices 1330 may be collectively deployed as well.

In some embodiments, medical device 1300 may further include anexpandable member 1318 on an exterior surface of elongate member 1310.Expandable member 1318 may be substantively similar to expandable member18 of medical device 10 shown in FIG. 1 . For example, expandable member1318 may be an occluder in the form of a vaginal dam for preventingleakage of a gas upon inflation of a patient's abdomen. Expandablemember 1318 may also be connected to expansion control line 1326 formoving expandable member 1318 between deployed and retractedconfigurations. In embodiments where expandable member 1318 isinflatable, expansion control line 1326 may provide a passageway forinflation fluids. Expandable member 1318 may also include sensors,radiopaque markers, and/or pressure limiting valves for monitoring theforce expandable member 1318 may exert on a patient's tissue and formonitoring the relative expansion of expandable member 1318.

FIG. 27 illustrates another medical device 1400 for performing an LSHprocedure, in accordance with an eighth embodiment of the presentdisclosure. Medical device 1400 may include one or more features of anyof the embodiments disclosed herein. For example, elongate member 1410,end effector assembly 1414, and cutting device 1430 may be substantivelysimilar to elongate member 1310, end effector assembly 1314, and cuttingdevice 1330, respectively, of medical device 1300 in FIG. 23 . Further,medical device 1400 may include an expandable member (not shown) onelongate member 1410 that is substantially similar to expandable member1318 of medical device 1300 in FIG. 23 .

Elongate member 1410 may be a curved, hollow tube that may be a unitarystructure or may include two halves 1410′. Elongate member 1410 may beany shape and/or configuration, and may be made of a biocompatiblematerial with sufficient flexibility/rigidity to traverse a patient'svaginal and uterine cavities. Elongate member 1410 may further include aproximal end 1410 a, a distal end 1410 b, and an opening 1425. Opening1425 may be substantively similar to opening 1325 in elongate member1310 shown in FIG. 23 . For example, opening 1425 may serve as anentry/exit point for an electrical line 1424 that may be connected tocutting device 1430. Further, distal end 1410 b may be substantivelysimilar to distal end 1310 b of medical device 1300 shown in FIG. 23 .For example, distal end 1410 b may include threads 1450 configured tomate with corresponding threads 1451 on end effector assembly 1414.Distal end 1410 b may also include a stop surface 1452 for limitingmovement of end effector assembly 1414 relative to elongate member 1410.Other embodiments of medical device 1400 may include a cup (not shown)configured to engage vaginal/cervical tissue to make them taut.

End effector assembly 1414 may be substantively similar to end effectorassembly 1314 of medical device 1300 shown in FIG. 23 . For example, endeffector assembly 1414 may include a manipulation device 1422 that issubstantively similar to manipulation device 1322 of medical device 1300shown in FIG. 23 . As illustrated in FIG. 27 , manipulation device 1422may be a substantially straight, elongate member. Alternatively,manipulation device 1422 may include an S-shaped configuration, or anyother suitable geometric features, along its length, similar tomanipulation device 1322 shown in FIG. 23 . Manipulation device 1422 mayalso include an expandable member (not shown) for securing medicaldevice 1400 relative to a uterus and/or for tensioning the uterine wallin an area of an incision made by cutting device 1430, as discussedabove in relation to manipulation device 1322 shown in FIG. 23 .

End effector assembly 1414 may also include a connector portion 1420that is substantively similar to connector portion 1320 of medicaldevice 1300 shown in FIG. 23 . For example, connector portion 1420 maybe a hollow structure having an opening at a distal end with a diametersufficient to receive distal end 1410 b of elongate member 1410.Further, as discussed above, connector portion 1420 may include threads1451 configured to mate with threads 1450 on distal end 1410 b ofelongate member. Connector portion 1420 may also include a texturedgripping portion on an exterior surface thereby allowing a deviceoperator to move end effector assembly 1414 relative to elongate member1410.

Proximal end 1410 a of elongate member 1410 may include first and secondseats 1454, 1455 for housing first and second actuating mechanisms 1416,1418, which may control movement of cutting device 1430. Although thedepicted embodiment illustrates two such seats, those of ordinary skillin the art will recognize that a greater or lesser number of seats maybe provided on elongate member 1410. First seat 1454 may be an openingthrough the exterior surface of elongate member 1410 and may be incommunication with a central lumen 1448 in elongate member 1410. Asillustrated in FIG. 29 , the opening of first seat 1454 may include aback portion 1446 such that the opening may not extend completelythrough elongate member 1410. Second seat 1455 may be a ledge atproximal end 1410 a of elongate member 1410 with an opening incommunication with central lumen 1448 of elongate member 1410 (FIG. 29). Second seat 1455 may also be located at the proximal-most portion ofmedical device 1400. Indeed, a portion of second seat 1455 may include aproximal end face of elongate member 1410.

As discussed above, medical device 1400 may include first and secondactuating mechanisms 1418, 1416 for controlling movement of cuttingdevice 1430. First and second actuating mechanisms 1418, 1416 may be anymovable device capable of deploying and rotating cutting device 1430,including, but not limited to, thumbwheels, push buttons, and switches.In one embodiment, first and second actuating mechanisms 1418, 1416 maybe knobs capable of rotating in the directions of arrows 1417 and 1419,respectively (FIGS. 28A-28B). Rotation of first actuating mechanism 1418may control deployment of cutting device 1430 in the directions of arrow1431, and rotation of second actuating mechanism 1416 may controlrotation of manipulation device 1422 with cutting device 1430 relativeto elongate member 1410 in the directions of arrow 1421.

As shown in FIGS. 29 and 30 , medical device 1400 may further includemultiple components in operable communication with first and secondactuating mechanisms 1418, 1416 for controlling deployment and rotationof cutting device 1430. First actuating mechanism 1418 may include afirst rod 1440, which may be in communication via a screw mechanism witha first end 1441 of a first plunger 1438, housed within central lumen1448 of elongate member 1410. A second end 1443 of first plunger 1438may be in communication with a second rod 1442 pivotally attached tocutting device 1430. In its retracted position (not shown), cuttingdevice 1430 may be housed within an opening 1426 in manipulation device1422 (FIG. 30 ). Medical device 1400 may also include a plurality ofbearings 1432 to provide rotational support. Bearings 1432 may also actas stop surfaces and aid in maintaining desired distances betweencertain components (FIG. 30 ). In use, rotation of first actuatingmechanism 1418 may cause first rod 1440 to act on first plunger 1438,and in turn, act on second rod 1442 to pivot cutting device 1430 to adeployed configuration (FIG. 28A).

Second actuating mechanism 1416 may further include a third rod 1434that acts on a second plunger 1436. Rotation of second actuatingmechanism 1416 may cause second plunger 1436 to translate a rotationalforce to a proximal end of manipulation device 1422, which subsequentlymay result in rotation of manipulation device 1422 and cutting device1430 relative to elongate member 1410.

Cutting device 1430 may be substantively similar to cutting device 1330of medical device 1300 shown in FIG. 23 . For example, cutting device1430 may be any cutting device known to those of skill in the art, suchas a laser, RF device, or microwave probe. FIG. 30 illustrates thatcutting device 1430 may also be a flat, cautery blade connected toelectrical line 1424, which may be connected to an external energysource (not shown). Further, as shown in FIGS. 28A-28B and 30 , cuttingdevice 1430 may deploy at any suitable angle (e.g., 45 degrees, 90degrees, etc.).

FIGS. 31A and 31B of the present disclosure illustrate an embodiment ofa method for performing an LSH procedure using medical device 1300 ofFIG. 23 . Alternatively, medical device 1400 of FIG. 27 may be used forthe LSH procedure in place of medical device 1300 of FIG. 23 . Themethod illustrated in FIGS. 31A and 31B follows the same preparationsteps as illustrated in FIGS. 5A-5C and 6 . A device operator may movehandle portion 1312 in the direction of arrow 1313, such thattelescoping portion 1317 may slide within lumen 1344 of elongate member1310, in the direction of arrow 1313, to deploy cutting device 1330. Thedevice operator may then rotate handle portion 1312 in the direction ofarrow 1311, such that cutting device 1330 may rotate relative toelongate member 1310 in order to create a uniform, rounded incision toexcise the uterine fundus 510 from the cervix, which is left in situ.The uterine fundus 510 is then withdrawn using accepted techniques, andthe vaginal cuff opening left behind may be sutured or otherwise closedas known to those skilled in the art.

FIGS. 31C and 31D of the present disclosure illustrate an embodiment ofa method for performing an conoscopy of the cervix. A conoscopy of thecervix may involve coring out tissue in the cervix after the uterinefundus 510 is removed during an LSH procedure. A device operator mayposition medical device 1300 for a conoscopy by partially retractingcutting device 1330 and by moving end effector assembly 1314 relative toelongate member 1310 in the direction of arrow 1325. Cutting device 1330may be partially retracted, as shown in FIG. 31C, in the direction ofarrow 1319, until a desired angle of cutting device 1330 is reached. Thedesired angle may be in the range of fifteen (15) to ninety (90)degrees, inclusive. FIG. 31D illustrates that, upon retracting cuttingdevice 1330 to the desired angle, the device operator may rotate handleportion 1312 in the direction of arrow 1311 in order to rotate cuttingdevice 1330 relative to elongate member 1310, such that coring ofcervical tissue may be achieved.

FIGS. 32A-32D illustrate a medical device 1800 for performing an LSHprocedure according to a ninth embodiment of the present disclosure.FIGS. 32A-32D also illustrate a method for performing an LSH procedureand a conoscopy using the ninth embodiment of the present disclosure.Medical device 1800 may be substantively similar to medical device 1300shown in FIG. 23 and medical device 1400 shown in FIG. 27 . For example,medical device 1800 may include an elongate member 1810, a manipulationdevice 1822, a cutting device 1830, and a connector portion 1820.Elongate member 1810, manipulation device 1822, and cutting device 1830may be substantively similar to elongate member 1310, manipulationdevice 1322, and cutting device 1330, respectively, of medical device1300 in FIG. 23 . Manipulation device 1822 may include an expandablemember 1824 for tensioning the uterine wall, as discussed above inrelation to manipulation device 1322 of medical device 1300 shown inFIG. 23 . Alternatively, tensioning of uterine wall may be accomplishedusing any means known to those skilled in the art. For example,tensioning of uterine wall may occur via gripping tools (e.g., forceps,prongs) that may extend through any suitable lumen in medical device1800 and into the uterine cavity to grasp the uterine wall.Alternatively, a gripping tool (not shown) may be advanced into apatient's abdominal cavity through, e.g., a laparoscopic port, tofacilitate gripping a portion of the patient's uterus and pullingproximally. Additionally, connector portion 1820 may be a cup forapplying a cephalad force to a patient such that fornices 508 may betented, thereby creating space and allowing easier removal of theuterine fundus 510.

In use, after a patient is prepared and medical device 1800 is inserted,a device operator may push medical device 1800 to apply a cephalad forcein the directions of arrow 1811 to tent fornices 508. The deviceoperator may then deploy cutting device 1830 in the directions of arrow1821, as illustrated in FIG. 32B. Prior to rotating cutting device 1830,the device operator may expand expandable member 1824 on manipulationdevice 1822 in order to exert tensioning forces on the uterine wall atan area of the incision in the directions of arrow 1823. Cutting device1830 may then be rotated in the directions of arrow 1825 in order toexcise the uterine fundus 510 and perform a conoscopy procedure. Thevaginal cuff opening left behind may be sutured or otherwise closed asknown to those skilled in the art.

FIGS. 33A and 33B illustrate a medical device 1500 for performing an LSHprocedure, according to a tenth embodiment of the present disclosure.Medical device 1500 may include one or more features of the embodimentsdisclosed herein. For example, medical device 1500 may include aconnector portion 1520, a manipulation device 1522, and a cutting device1530. As an alternative to an elongate blade, cutting device 1530 may belocated on an expandable member 1521. Cutting device 1530 may be anycutting device 1530 known to those skilled in the art, including, butnot limited to, a ring affixed to expandable member 1521 orindividual/segmented cutting portions affixed to expandable member 1521at predetermined positions. Expandable member 1521 may be substantivelysimilar to expandable members 18 and 26 of medical device 10, shown inFIG. 1 . For example, expandable member 1521 may include an expansionline (not show) and may be any expandable member 1521 known to thoseskilled in the art, including, but not limited to, a balloon, a cage,and an open cell foam. In some embodiments, expandable member 1521 maybe self-expanding. Expandable member 1521 may also include pressuresensors, pressure valves, and/or radiopaque markers for sensing and/orvisualizing relative expansion of expandable member 1521.

Cutting device 1530 may include a retracted configuration (FIG. 33A) anda deployed configuration (FIG. 33B). In the retracted position, medicaldevice 1500 may include a sheath 1524 that may protect tissue fromcutting device 1530; and in the deployed configuration, sheath 1524 maybe removed and expandable member 1521 may be expanded using techniquesknown to those skilled in the art. In use, a device operator may movesheath 1524 in the directions of arrow 1523 and expand expandable member1521 into the deployed configuration, thus allowing cutting device 1530to contact and pierce a patient's tissue. The device operator mayfurther rotate a handle portion of medical device 1500 (not shown) inorder to rotate manipulation device 1522 with cutting device 1530relative to an elongate member (not shown), creating a uniform, roundedincision to excise the uterine fundus 510.

FIGS. 34A and 34B illustrate an end effector assembly 1614 forperforming a conoscopy of the cervix, in accordance with an eleventhembodiment of the present disclosure. End effector assembly 1614 mayinclude one or more features of end effector assemblies 1314 and 1414,shown in FIGS. 23 and 27 , respectively. For example, end effectorassembly 1614 may include a connector portion 1620, a manipulationdevice 1622, and a cutting device 1630. As an alternative to an elongateblade, cutting device 1630 may be a sharpened edge of an opening that isintegral with manipulation device 1622. Further, manipulation device1622 may be located at an outer edge of connector portion 1620 and mayinclude a curved outer surface. Manipulation device 1622 may also beangled relative to a longitudinal axis of connector portion 1620. Edgesof cutting device 1630 may be sharp enough to core out tissue as cuttingdevice 1630 is rotated relative to an elongate member (not shown) duringa conoscopy procedure.

FIGS. 35A and 35B illustrate another end effector assembly 1714 forperforming a conoscopy of the cervix, in accordance with a twelfthembodiment of the present disclosure. End effector assembly 1714 mayinclude one or more features of end effector assemblies 1314 and 1414,shown in FIGS. 23 and 27 , respectively. For example, end effectorassembly 1714 may include a connector portion 1720, a manipulationdevice 1722, and a cutting device 1730. Cutting device 1730 may includea retracted configuration (FIG. 35A) and a deployed configuration (FIG.35B). Cutting device 1730 may be any known cutting device to thoseskilled in the art, such as, for example, an elongate blade, and may beattached to deployment bars 1734, 1736, and 1738 per linkages 1732.

In use, a device operator may move first deployment bar 1734 in thedirection of arrow 1731, and second deployment bars 1736, 1738 may bepivoted to a horizontal configuration (FIG. 35B), which may push cuttingdevice 1730 out of manipulation device 1722. Manipulation device 1722with cutting device 1730 may further be rotated relative to an elongatemember (not shown) in the direction of arrow 1721 in order to core outcervical tissue during a conoscopy procedure. Alternatively, an end ofcutting device 1730 may be disconnected from one second deployment bar1736 or 1738 and linkage 1732 in order to deploy cutting device 1730 ata suitable angle for an LSH procedure.

Those of ordinary skill in the art will readily recognize that any ofthe above-described devices and methods, or aspects thereof, may beautomated with the aid of, e.g., a computer or suitable processingcircuitry. In such embodiments, the computer or processor may includesuitable algorithms or logic to activate and effect any of the aspectsdescribed above. For example, the computer may be configured to effectdeployment of a cutting device. In another embodiment, the computer maybe configured to automatically move the cutting device to excise tissue.

Other embodiments of the present disclosure will be apparent to thoseskilled in the art from consideration of the specification and practiceof the present disclosure disclosed herein. It is intended that thespecification and examples be considered as exemplary only, with a truescope and spirit of the present disclosure being indicated by thefollowing claims.

What is claimed is:
 1. A medical device for performing a surgicalprocedure, the medical device comprising: an elongate member having aproximal end, a distal end, and a lumen extending therebetween; a cupconnected to the distal end of the elongate member, the cup including afirst wall and a second wall; and a cutting device configured to extendfrom the cup, the cutting device having (1) a retracted configuration inwhich a distal end of the cutting device is disposed between the firstwall and the second wall without projecting longitudinally beyond eitherof the first wall or the second wall; and (2) a deployed configurationin which the distal end of the cutting device projects from between thefirst wall and the second wall thereby extending from the cup.
 2. Themedical device of claim 1, wherein the cup includes an elongatemanipulation member having a proximal portion, a distal portion, and acentral portion extending therebetween, wherein the central portionincludes a substantially uniform cross-section.
 3. The medical device ofclaim 1, wherein the cup is configured to pivot relative to the elongatemember.
 4. The medical device of claim 3, wherein a first actuatorcontrols deployment of the cutting device.
 5. The medical device ofclaim 3, wherein the cutting device is a monopolar cauterizinginstrument.
 6. The medical device of claim 3, further comprising anexpandable member secured to a distal portion of the medical device. 7.The medical device of claim 6, wherein the expandable member is securedto the elongate member.
 8. The medical device of claim 7, wherein theexpandable member is disposed proximally of the cup.
 9. The medicaldevice of claim 3, further comprising an expandable member secured to anelongate manipulation member.
 10. The medical device of claim 3, furthercomprising an elongate manipulation member extending distally fromwithin the cup.
 11. The medical device of claim 10, further comprising afirst expandable member secured to a distal portion of the elongatemember.
 12. The medical device of claim 11, further comprising a secondexpandable member secured to the elongate manipulation member.
 13. Themedical device of claim 1, wherein the cutting device is a bipolarcauterizing instrument.
 14. The medical device of claim 1, wherein thecup is removably secured to the distal end of the elongate member. 15.The medical device of claim 1, wherein the cup is longitudinally movablerelative to a distal end of the elongate member.
 16. The medical deviceof claim 1, wherein the first wall is an outside wall of the cup and thesecond wall is an inside wall of the cup.
 17. A method for performing alaparoscopic hysterectomy procedure, the method comprising: inserting amedical device into a vaginal canal of a patient, the medical devicecomprising: an elongate member having a proximal end, a distal end, anda lumen extending therebetween; a cup connected to the distal end of theelongate member, the cup including a first wall and a second wall; and acutting device configured to extend from the cup, the cutting devicehaving (1) a retracted configuration in which a distal end of thecutting device is disposed between the first wall and the second wallwithout projecting longitudinally beyond either of the first wall or thesecond wall; and (2) a deployed configuration in which the distal end ofthe cutting device projects from between the first wall and the secondwall thereby extending from the cup; positioning the cup adjacent tissueassociated with one of uterine or cervical tissues; deploying thecutting device; and creating an incision to excise at least a uterus ofthe patient from surrounding tissue.
 18. The method of claim 17, whereinthe medical device further includes a first expandable member disposedon an elongate manipulation member extending distally from within thecup at a location proximal of the cup.
 19. The method of claim 18,further comprising expanding the expandable member to occlude thevaginal canal.
 20. The method of claim 18, wherein the medical deviceincludes a second expandable member secured to the elongate manipulationmember.
 21. The method of claim 17, wherein the medical device includesan elongate manipulation member extending distally from within the cup,and prior to the step of deploying the cutting device, the methodfurther includes pivoting the elongate manipulation member to alter apositioning of the uterus.
 22. The method of claim 17, wherein, prior tothe step of deploying the cutting device, the method further includespositioning a rim of the cup against a vaginal fornice and exerting acephalad force on the vaginal fornice.
 23. The method of claim 17,wherein creating an incision to separate at least a uterus of thepatient from surrounding tissue includes rotating the cutting device.24. The method of claim 23, wherein rotating the cutting device includesrotating the cup.
 25. The method of claim 17, wherein the cutting deviceis a monopolar cautery instrument.
 26. The method of claim 17, whereinthe cutting device is a bipolar cautery instrument.
 27. The method ofclaim 17, wherein the cup is removably secured to the distal end of theelongate member.
 28. The method of claim 17, wherein the cup islongitudinally moveable relative to the distal end of the elongatemember.
 29. The method of claim 17, further comprising the step ofremoving cervical tissue.
 30. The method of claim 17, wherein creatingan incision to excise at least a uterus of the patient from surroundingtissue includes excising the uterus and a cervix of the patient.
 31. Themethod of claim 17, wherein the first wall is an outside wall of the cupand the second wall is an inside wall of the cup.
 32. A medical devicefor performing a surgical procedure, the medical device comprising: anelongate member having a proximal end, a distal end, and a lumenextending therebetween; cup connected to the distal end of the elongatemember, the cup including a first wall and a second wall; a cuttingdevice configured to extend from the cup, the cutting device having aretracted configuration in which a distal end of the cutting device isdisposed between the first wall and the second wall without projectinglongitudinally beyond either of the first wall or the second wall; and(2) a deployed configuration in which the distal end of the cuttingdevice projects from between the first wall and the second wall therebyextending from the cup; and an expandable member positioned on theelongate member at a location proximal of the cup.
 33. The medicaldevice of claim 32, wherein the first wall is an outside wall of the cupand the second wall is an inside wall of the cup.